Pediatric Oncology

Pediatric Oncology
STAGES OF CANCER TREATMENT

Induction Goal: to remove bulk of tumor Methods: surgery, radiation/chemotherapy, bone marrow transplant Effects: often the most intensive phase; side effects of treatment are potentially life threatening Consolidation Goal: to eliminate any remaining malignant cells Methods: often chemotherapy/radiation therapy Effects: side effects will still be evident Maintenance Goal: to keep child disease free Method: chemotherapy (this phase may last for several years) Observation Goal: to monitor the child at intervals for evidence of recurrent disease and complications of treatment Method: treatment is complete; child may continue in this stage indefinitely Late effects of treatment Impaired growth and development, usually related to radiation of growth centers CNS damage resulting in intellectual, psychologic, or neurologic sequelae Impaired pubertal development including hormonal or reproductive problems Development of secondary malignancy Psychologic problems (poor self-esteem, depression, anxiety) related to living with a life-threatening disease and complex treatment regimen Side Effects From combined effects of treatment: nausea, vomiting, diarrhea, alopecia, anemia (low RBCs), increased susceptibility to infection (low WBCs), bleeding (low platelets), stomatitis, mucositis, pain, learning problems From radiation (findings differ according to site radiated): sleepiness, reddened skin From chemotherapy: drug toxicity specific to agents used Developmental: behavior problems, avoidance of school and friends, low self-esteem or self-image Nursing Interventions Help child cope with intrusive procedures. Provide information geared to developmental level and emotional readiness. Explain what is going to happen, why it is necessary, and how it will feel. Allow child to handle and manipulate equipment. Use needle play as indicated. Allow child some control in situations (e.g., positioning, selecting injection site). Support child and parents. Maintain frequent clinical conferences to keep all informed. Always tell the truth. Acknowledge feelings and encourage child/family to express them, assure them that feelings are normal. Provide contact with another parent or an organized support group such as Candlelighters. Try to keep daily life as normal as possible. Minimize side effects of treatment. Skin breakdown Keep clean and dry; wash with warm water, no soaps or creams. Do not wash off radiation markings. Avoid exposure to sunlight. Avoid all topical agents with alcohol (perfumes and powders). Do not use electric heating pads or hot water bottles. Bone marrow suppression Decreased RBCs allow child to determine activities. provide frequent rest periods. Decreased WBCs avoid crowds, isolate from children with known communicable disease. evaluate any potential site of infection. monitor temperature elevations. Decreased platelets make environment safe. select activities that are physically safe. avoid use of salicylates. Administer transfusions as ordered. Interpret peripheral blood counts to guide specific interventions and precautions. Nausea and vomiting Administer antiemetic at least half an hour before chemotherapy; repeat as necessary. Encourage relaxation techniques. Eat light meal prior to administration of therapy. Ensure adequate oral intake or administer IV fluids as necessary. Alopecia Reduce trauma of hair loss (especially in children over age 5 years). Buy wig before hair falls out. Discuss various head coverings with boys and girls. Avoid exposing head to sunlight. Discuss feelings. Stomatitis, mucositis (see Pediatric Oncology - Bone Marrow Transplant in Unit 5). Nutrition deficits Establish baseline prior to start of treatment. Measure height and weight regularly. Provide small, frequent meals. Consult dietitian as needed. Provide high-calorie, high-protein supplements. Developmental delays Discuss limit setting, discipline. Some behavior problems might be side effects of drug therapy. Facilitate return to school as soon as able. Realize changing needs of child.